Words Like Loaded Pistols

I just finished reading Words Like Loaded Pistols: Rhetoric from Aristotle to Obama.  I picked it up last Sunday after it appeared prominently in the sermon.  At 322 pages I expected to be finished with the book Monday night.  I was wrong.  It was one of those books where I needed to read a chapter (or two), and take some time to digest.  What it had to say.  A book that I cannot finish in a few short hours, but want keep reading is a rare pleasure.

One of my favorite things about the book is how the author (Sam Leith) is how much fun he is clearly having a) writing the book, b) using the text as an example of rhetorical figures and tropes, and c) choosing fun examples (dissecting Kyle's Mom is a Bitch from South Park).

Whether you need convince a client, a colleague, or a CEO*, this is simply a book worth reading.

   -- Keith

* The book calls this rhetorical figure a Rising Tricolon

Book Review: Ten Faces of Innovation

Friday, a book showed up in my mailbox, sent to me by my manager's manager. It saved me a trip to the bookstore for airplane reading, since I travelled to the HL7 Working Group meeting yesterday. The Ten Faces of Innovation is written by Tom Kelly of IDEO. IDEO is a design and innovation consulting firm that has worked with many large organizations; showing them how improve their innovation skills. I finished reading it on the plane yesterday. In brief, the author describes 10 key roles that are important to promote innovative ideas within an organization.

Anthropoligist

The person who views a process from the customer's viewpoint.
I've done this a few times and really enjoy it. I don't get the opportunity to do it often enough. My favorite experience was playing fly-on-the-wall during rounds at Intermountain

Experimenter

The person who enjoys quickly prototyping and demonstrating possible solutions.
I've built a number of prototypes over the years for IHE Connectathons and demonstrations (one of my favories is here). Some of them have made it into production systems, which I always find pleasing.

Cross-Pollinator

Someone with breadth in many spaces who can bring experiences from another domain into the problem domain.
Bringing together past experiences with current actiivities is something I did in this post.

Hurdler

A can-do person who figures out how to get over (or around/through/under) obstacles in creative ways.
My favorite method is around, after all, it is easier to get forgiveness than permission ;-)

Collaborator

A person who brings diverse groups together to solve a problem
I'm less of a collaborator that brings together dierse groups, and more of one of those people who gets pulled in to diverse groups

Director

Someone with the overall vision that helps the team solve problem.
Sometimes I have visions. It could be the hour, or too much caffeine, but at least they are consistent. But I'm not very good at building the right team and getting out of their way.

Experience Architect

Someone who looks at and develops the customer experience, thinking about "what are we trying to do" in refreshing ways
That's one of my favorite questions

Set Designer

A role that looks at how spaces and people interact
I've moved my office to be closer to people that I interact with, but these days that's a bit difficult

Care Giver

A role that anticipates customer needs and delivers what is needed to them.

Story Teller

Someone who communicates fundamental insights by relating them to well told, authentic stories
A lot of what I write here is storytelling.

In any book looking at and classifying roles, of course my first response was to find myself. You can see my comments on where I found myself in italics. The author points out that these are roles on a team, and that different team members may take on multiple roles at different times as appropriate.
One role that I've often taken up that he also mentions is that of "Devil's Advocate". While I won't ditch that role, I think I'll try to combine it with the others so that when I find problems, I also think about solutions.

HTML5 BookReview

One of the "gimme's" at the O'Reilly HealthFoo event was a free e-Book (from O'Reilly of course).  Since I no longer code HTML pages for my day job, I'm a bit behind on the current state of affairs with HTML 5.  So, I picked out a likely sounding title from the list yesterday.  Today I downloaded, and just finished reading Mark Pilgrim's HTML5: Up and Running.  


As tech-books go, this one won't make the average uber-HTML-geek happy, but it fit my profile just fine.  The typical tech-book is either reference, or tutorial (some do both).  This book didn't fit either of those patterns.  It provided some interesting history of HTML at the beginning.  The biggest focus of the book was describing some key features of HTML5.

The key features Mark described were:

• Article Structure
• Canvas
• Video and Audio tags
• New Input Controls
• Micro-Data
• Offline Applications
• Local Storage
• Geolocation

He describes quickly the benefits of each, support for them in common browsers, and enough about how they work that your boss could understand it.  If you aren't an HTML uber-geek, this is a good place to get started, but don't expect to learn how to make wicked cool HTML 5 apps that run on tablets from this book.  It just doesn't go to that level of detail. 

Overall, its a good, quick overview of HTML 5.

-- Keith

P.S. I have an interesting idea to explore wrt microdata and CDA R3, that I'll talk more about later

Book Review: Information Retrieval: A Health and Biomedical Perspective

I just finished my first reading of the Third Edition of William Hersh's Information Retrieval: A Health and Biomedical Perspective (Health Informatics).  It's quite dense so I will have to go back through it again several times.  If you want to understand why computers, the web, and search engine technology haven't yet made evidence based medicine ubiquitous, you should read this text.

Bill doesn't spend much time explaining the mechanics of how to implement information retrieval systems.  For that, my well-thumbed favorites include Information Retrieval: Data Structures and Algorithms and Managing Gigabytes: Compressing and Indexing Documents and Images, Second Edition.  He mentions the former in chapter 1 along with several other texts.

What Bill does explain quite well are the challenges of Information Retrieval as it relates to the practice of medicine and medical research, and vice versa.  As I said, this was, even to one who is well versed in IR topics (having worked in IR and linguistics for 10 years), quite dense content, and full of usefull information and references.  Quite a bit of the book focuses on the work of the National Library of Medicine, including PubMed and MEDLINE.

What I found most disappointing in the book was the rather scarce coverage of Information Retrieval as it applies to the electronic health record, but I should not be surprised.  That lack is not Bill's fault.  It is up to our generation to apply IR technology to the EHR, just as it was up to prior generations to apply them to electronic text and the web.  Chapter 9 delves into some of the issues of Information Extraction from medical records, something I spent about 4 years working on in a prior job.  Coverage is a little bit thin in this area, but then again, some of the products that do this today in a very small way (tagging utterances in text) are only just now emerging into the medical marketplace, nearly a decade after I started working on them.

Bill is very well versed in his topic.  Lotka's law (see page 49 of his book) seems to hold if you look at the rather extensive (64 pages) of references that he includes in the back.  While I would certainly expect some bias towards his own publications, only Anonymous seems to be more prolific in this space.

Bill also writes a blog.  You can find him at Informatics Professor.  I usually find his posts to be worth reading and tweeting about.

   - Keith

P.S.  In the interest of full disclosure, Bill gave me this copy, just as I will be giving him a copy of my book.

Book Review: The Ten Commandments for Effective Standards by @karenbartleson

The Ten Commandments for Effective Standards
Subtitled "Practical Insights for Creating Technical Standards", Karen Barlteson's new (May 2010) book is a must read for anyone wanting to get involved in Standardization Efforts, here in the US or Internationally.  It's a quick read and it contains exactly what the subtitle claims.  I polished it off after dinner (it arrived today) in about 45 minutes. 

Earlier this year I was asked to put together a class on Standards along with some of my colleagues for engineering master's degree students (not just in healthcare).  It was to last four hours, have about two days worth of homework and we were asked to recommend a text book.  We had no recommendations for texts, just a few good articles on the web here and there.  I just went back into the curriculumn and added this book as the text.

The book is very short, checking in at just under 100 pages of content (with about 25 pages or so of footnotes, references, and an index).  It can easily be read in one sitting (even if you aren't a speed reader).  It's also a picture book, as all of Ms. Bartleson's commandments are very well illustrated by Rick Jamison as demonstrated here.  I want the clip art!

Since you can get the 10 Commandments from the Table of Contents at Amazon, I don't have a problem listing them here.

1. Cooperate on Standards, Compete on Products
2. Use Caution when Mixing Patents and Standards
3. Know When to Stop
4. Be Truly Open
5. Realize there is No Neutral Party
6. Leverage Existing Organizations and Proven Processes
7. Think Relevance
8. Recognize that there is More than One Way to Create a Standard
9. Start with Contributions, Not from Scratch
10. Know that Standards Have Technical and Business Aspects

It was based on this short list of titles alone that I purchased the book online.  I may have less money now but I'm certainly richer for the experience. 

Karen also happens to write a blog on guess what ... standards.  It's called the Standards Game and is also worth reading.  But I have to go back and read this book again, just a little bit more slowly this time.  There has to be something in there that I can disagree with...

     Keith

Book Review: The Innovator's Dilemma

On the advice of a collegue I picked up a copy of The Innovator's Dilemma by Clayton M. Christensen yesterday.  I'm more than two thirds of the way through it and heartily recommend it to anyone involved in Healthcare IT.  It includes case studies of several industries, including a couple that will be familiar to IT folks:

• Hard Disk Drives
• Microcomputers
• Discount Retailers
• Steel Mills
• Excavators 

The case studies are more than just anecdotal narrative.  The author puts together some very compelling evidence based on detailed research about how disruptive innovation causes well managed companies to fail.  While the book was written more than 10 years ago, the advice given is still very sound.  Even as the author describes events from a decade ago, I found myself identifying more recent events (the rise of solid state storage and the USB memory stick, the laptop computer, the PDA and the smart phone), which follow similar patterns.

In almost all cases of innovation that Christensen describes, the disruptive innovation starts downmarket, and eventually creaps upmarket to displace prior market leaders.  The importance of this work in Healthcare IT comes from couple of sources of disruptive innovation:

• The Health Information Exchange as a platform for electronic health records.
• The emergence of lightweight EMR products and Software as a Service (SaaS).
• The interest in easier to use standards with a lower point of entry (e.g., NHIN Direct vs. NHIN CONNECT, Green CDA and CCR vs. CDA and CCD, REST vs. SOAP)

The HIE space is arguably not "downmarket" from the EHR space but it is definately a new market.

Christensen has two other books that follow up on The Innovator's Dilemma, one titled The Innovator's Solution, and a third titled The Innovator's Prescription which is specific to healthcare.  Based on what I've read so far, I'll be purchasing the next two shortly.

Book Review

Not too long ago, I ordered a copy of "Critical: What we can do about the Health-Care Crisis", by Senator Tom Daschle (President-Elect Obama's choice for Secretary of HHS) with Scott Greenberger and Jeanne Lambrew. The book was sold out in my local bookstores, so I ordered it online. It arrived yesterday, and I've just finished reading it today.

The book itself is fairly short, about 200 pages. Organized into five parts, the book first introduces the crisis in healthcare, talks about what's been done to reform healthcare in the last century, and describes why these efforts failed. Next it describes the Sentator's ideas for solving the problem. He closes by calling for change in the healthcare system that sticks. I found the first three parts of the book to be of little interest personally. However, I understand why they are included in the book.

The key focus of the book is the notion of a Federal Health Board, and independent body modeled after the Federal Reserve. The members of the board would be experts in healthcare appointed by the President, and approved by Congress. The board would set policy on how private insurers participate in Federal health programs. It would recommend coverage of proven drugs, procedures and therapies for the treatment of specific diseases. What makes the idea of the FHB march is the expansion of the Federal employee health benefits and Medicare programs to include plans that would allow members of the public to participate. It might also unify federal coverage so that members of the military, the Federal government, and those obtaining care under Medicare obtain similar benefits for similar costs.

Other key objectives of the FHB made in the book include:

• Focusing on prevention
• Ensuring universal coverage
• Equity not just for general healthcare, but also dental and mental health coverage

In addition to these goals, the FHB would also continue existing programs to increase transparency into healthcare costs, improve and measure quality of care, and change the focus from payment for services to payment for performance.
Daschle speaks somewhat about the use of electronic health records in the book, but devotes only a handful of pages to the topic. He notes that the US is woefully behind the rest of the world in use of healthcare information technology, and that we could save as much as five percent of our total healthcare spending (some $1.66 trillion in 2003) by implementation of a fully electronic healthcare system. He suggests tax breaks, loans or loan-guarantees to health-care institutions to enable them to upgrade their health IT systems.
This isn't a great book, but it does have some interesting insights. If you will be dealing with healthcare policy issues in the US, I'd recommend reading it.